Arising out of the acute malarial condition is a chronic state of anaemia and malnutrition. No parasites may be discoverable in the blood. Indigestion, looseness of the bowels, headaches, with occasional rises of temperature without the typical malarial stages or periodicity, are commonly present. For such a case to require china the following features should be present: a pale or sallow complexion, sweating on slight exertion, inability to digest fruit or acid things, sensitiveness to cold air, with susceptibility to taking cold, shooting pains about the body, causing restlessness, necessitating movement. A very characteristic china symptom is surface tenderness to a light tough, but relief from firm pressure.
The prevailing mental condition is one of nervous irritability, with hyperaesthesia of the special senses, or on the contrary apathy and indifference. In either case mental effort for such patients is difficult and aggravates his general and mental state.
Periodicity is another element in the china pathogenesy; in a patient it need not be malarial to be benefited by the remedy, but in that disease the recurrences (when china is called for) are chiefly diurnal, while in nonmalarial neuralgia, dyspepsia, headache, &c., the recurrences are often about midnight, either every nigh or every second night (“tertian”).
Of the china neuralgias, supra-orbital pain is one of the most frequent; the paroxysm is brought on by moving the part, ever so gently, or by a light touch, and the pain is of a gradual crescendo character, with midnight origin or aggravation. Trembling or twitching of the limbs or of single muscles, and numbness of the parts lain on occur; the temperature and movement aggravations mentioned above are a part of the picture. The pains for which this remedy is required are often due to excessive loss of fluids-normal or pathological.
Loss of Fluids.-This source of ailments ranks almost as a keynote for china, loss of blood (traumatic, menstrual, epistaxis, &c.), excessive perspirations, seminal losses in excess, diarrhoea, &c., all may bring about china symptoms.
Haemorrhages.-China is useful for a number for a number of passive haemorrhages from such sources as nose, throat, bowel, uterus-mostly venous. Of course, in any such cases a local source should be sought for and dealt with. When none is found there will generally be some general state of the patient which will guide to the remedy, whether that state is the cause or the result of the haemorrhage. Sometimes ailments such as nerve pains, cramps and spasms, even convulsions, also local inflammations such as pneumonia or metritis, seem to follow a comparatively slight haemorrhage. The explanation probably is that the bleeding suddenly lowers an already low bodily resistance, and facilitates the development of some toxic or septic condition. Previous to the haemorrhage the patient would be a frail senses (odours, noises, light, &c.), pale, cachectic and with cold hands and feet. These, rather than the local post- haemorrhagic condition, would be the indications for china.
Digestive System.- Voracious appetite is a prominent china symptom. Small doses, taken by provers or inhaled by workers in quinine factories, cause diarrhoea, often containing undigested food. Gastro-duodenal catarrh, causing jaundice, is also produced. It is also curative in such conditions. The diarrhoea requiring china may be acute or chronic. The former is often found in the summer, accompanied by colicky pains. The stools vary from pale colour to brown, with undigested particles, and they are evacuated noisily with offensive gas, which has accumulated and distended the abdomen. Flatulent intestinal distension is very distressing and is not relieved by eructations.
Such an attack will be likely to be followed by colourless, constipated stools, headache, and slight jaundice. China will follow the condition in this development.
The chronic diarrhoea of china is a watery, painless action, frothy, brownish or black, and liable to be worse at night. This drug has gained a reputation in biliary colic which it is claimed to cure radically. On what ground this use of it was not clear, and we have no experience regarding it.
Respiratory System.- Cinchona does not appear to cause any local pulmonary lesions. It has been used in some asthmatic conditions, especially where there is stridor from laryngeal spasm or oedema of the glottis. The cough modalities may occasionally lead to the use of china for chest complaints. It is worse lying with the head low and on the left side, worse from draughts of cold air, on waking, in the evening or about midnight, and from any muscular exertion-laughing, talking, breathing deeply and moving about; also from eating and drinking. Loss of fluids, again, may be a pre-disposing cause. Some of the parietal pains of cases of cough or asthma may be reflected in the china pathogenesis-stitches, pressure, cutaneous hypersensitiveness (cannot bear percussion). Palpitation occurs in connection with febrile attacks but is not pathognomonic of china.
Limbs and Back.- A constricted feeling in the limbs, as if the clothing or garters were too tight, may draw attention to this remedy. Pain in the back, like pressure inwards, or like cramp, worse from any movement; tearing pains extending from back to thighs; darting, tearing pains, especially in hands and feet, gradually increasing; pains around joints; all these are worse from cold air and from movement, except that prolonged pain (as in bryonia cases) may impel to restless movement, though that is painful.
Sleeplessness before midnight or towards morning, from over- activity of the mind (constantly making plans), or unrefreshing sleep may be present in a china case.
Sexual Organs.- In men : excitement, with or followed by functional weakness; general debility following excessive genital stimulation and nocturnal emissions; tearing pain in the left cord and epididymis; these are the leading indications in this sphere. In women : dysmenorrhoea, with early and profuse, dark, clotted flow; fainting or convulsions from menorrhagia of “flooding” during childbirth ‘ acrid leucorrhoea; ovaritis, with great sensitiveness of the parts; any of these may present themselves in a china case.
Headaches.- Head pains are common, affecting either the whole head (bruised feeling), or the occiput (from loss of fluids), or a shooting from temple to temple. The character of the pain is bruised, shooting, throbbing or bursting; none of these may be very valuable as indications for the remedy, for they are very common. Coupled with the china modalities already mentioned they will lead to a reliable prescription.
Vertigo and noises in the head (ears) are well-known phenomena of cinchonism or quininism. The noises are ringing and humming, associated with temporary deafness. In poisonings ocular and aural disturbances develop, such as photophobia, colour distortions, contracted field and even blindness (usually temporary) and (in the case of the ears) cochlear origin. These are more often useful as leading to a choice of remedy in headaches and debility than in local, aural or ocular disease. They may, however, be called for in some early cases of nerve deafness or of retinitis.
LEADING INDICATIONS.
The modalities of china run through its pathogenesis with a considerable degree of consistency.
(1) Subjects.-Stout, pale, sallow, exhausted individuals who are anaemic and short of breath and very sensitive to cold air and liable to take cold.
(2) Surface Tenderness.-Sensitiveness to light touch but relief from firm pressure.
(3) Mental State.-nervous irritability with hyperaesthesia of special senses, or indifference and apathy; mental effort is difficult and aggravates the general and mental states; no wish to go on living.
(4) Periodicity. Daily or alternate days; recurrences near midnight, but in malarial cases paroxysms usually diurnal, tend to “anticipate.”
(5) Ailments due to or aggravated by loss of fluids, normal or pathological.
(6) Malarial Attacks.-For special homoeopathic indications, see p.359. These cover only a few malarial cases, whereas quinine in material doses is given for most acute cases.
(7) Haemorrhages and the [results of excessive or prolonged bleeding.
(8) Diarrhoea.-Acute, with colic; chronic, painless, with undigested food.
(9) Gastric symptoms from fish, sour things, wine, slow digestion and great flatulent distension not relieved by eructations.
(10) Neuralgias : supra-orbital, periodic; headaches; noises in the head and aural vertigo
(11) Tearing pains in bones or periosteum, causing restlessness and relieved by movement (exception to general modality).
(12) Febrile heat without thirst.
AGGRAVATION :
From movement (most symptoms, except bones, &c.); from draughts and cold air in general; from eating and drinking (respiration); during sleep (sweat); fruits and acids, touch or light pressure; at night (colic); evening (febrile chills); mental exertion.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,